本文選題：超聲斑點(diǎn)追蹤技術(shù) + 多巴酚丁胺負(fù)荷試驗(yàn)　； 參考：《暨南大學(xué)》2015年碩士論文

【摘要】：目的:本研究采用二維超聲斑點(diǎn)追蹤應(yīng)變及應(yīng)變率分析測(cè)定多巴酚丁胺負(fù)荷前后穩(wěn)定型心絞痛患者節(jié)段性心肌收縮及舒張功能的變化,探討多巴酚丁胺負(fù)荷二維超聲斑點(diǎn)追蹤應(yīng)變及應(yīng)變率分析早期診斷穩(wěn)定型心絞痛的臨床價(jià)值。方法:選取30例具有胸痛、胸悶等癥狀,臨床懷疑為穩(wěn)定型心絞痛的患者,進(jìn)行多巴酚丁胺負(fù)荷試驗(yàn),然后進(jìn)一步行冠脈CTA或冠脈造影檢查明確患者冠脈病變情況。根據(jù)冠脈CTA或冠脈造影檢查結(jié)果將所有受檢者分為冠心病組(20例)和無(wú)冠心病照組(10例)。分別在靜息、最大負(fù)荷以及復(fù)負(fù)荷后10min、30min、60min、120min、240min進(jìn)行超聲心動(dòng)圖檢查,采集并儲(chǔ)存受檢者左室短軸切面以及心尖四腔、兩腔、三腔切面的5個(gè)心動(dòng)周期的二維灰階動(dòng)態(tài)圖像。進(jìn)一步應(yīng)用QLab軟件對(duì)結(jié)果進(jìn)行脫機(jī)分析,分析測(cè)量左室各節(jié)段心肌的縱向收縮期峰值應(yīng)變及應(yīng)變率、圓周向收縮期峰值應(yīng)變及應(yīng)變率、縱向和圓周向舒張?jiān)�、晚期�?yīng)變率,并比較各組局部心肌收縮和舒張功能在負(fù)荷前后的變化及隨時(shí)間變化的情況。結(jié)果:靜息及最大負(fù)荷時(shí)所有受檢者常規(guī)超聲均未見(jiàn)節(jié)段性室壁運(yùn)動(dòng)異常。靜息時(shí),對(duì)照組和冠心病組心肌各節(jié)段縱向收縮期峰值應(yīng)變(LS)及應(yīng)變率(LSr)、圓周向收縮期峰值應(yīng)變(CS)及應(yīng)變率(CSr)、縱向舒張?jiān)缙�、晚期�?yīng)變率(LSRe、LSRa)及圓周向舒張?jiān)缙�、晚期�?yīng)變率(CSRe、CSRa)均無(wú)明顯差異(P0.05)。最大負(fù)荷狀態(tài)下,冠心病組缺血節(jié)段心肌的LS、CS明顯低于對(duì)照組及冠心病組非缺血節(jié)段心肌。最大負(fù)荷時(shí),對(duì)照組、冠心病非缺血節(jié)段、缺血節(jié)段LSr、CSr均較同組靜息狀態(tài)下降,且停藥后立即恢復(fù)基線水平。最大負(fù)荷時(shí),對(duì)照組、冠心病非缺血節(jié)段和缺血節(jié)段的LSRe、LSRa、CSRe和CSRa均明顯上升。停止使用多巴酚丁胺后LSRe立即下降,并低于基線水平,于30min恢復(fù),CSRe緩慢下降低于基線,于60min恢復(fù),LSRa、CSRa均緩慢下降30min到達(dá)基線水平。結(jié)論:本研究結(jié)果顯示,二維超聲多巴酚丁胺負(fù)荷試驗(yàn)未發(fā)現(xiàn)穩(wěn)定型冠心病患者節(jié)段性室壁收縮及舒張功能異常,而二維超聲斑點(diǎn)追蹤應(yīng)變及應(yīng)變率分析多巴酚丁胺負(fù)荷試驗(yàn)發(fā)現(xiàn)穩(wěn)定型冠心病患者出現(xiàn)節(jié)段性心肌收縮及舒張功能異常,說(shuō)明二維超聲斑點(diǎn)追蹤應(yīng)變及應(yīng)變率分析多巴酚丁胺負(fù)荷試驗(yàn)對(duì)于早期診斷穩(wěn)定型冠心病患者具有一定的臨床意義。
[Abstract]:Objective: to investigate the changes of myocardial systolic and diastolic function in patients with stable angina pectoris before and after dobutamine loading by using two dimensional ultrasonic speckle tracing strain and strain rate analysis. To investigate the clinical value of dobutamine load two-dimensional ultrasonic speckle tracing strain and strain rate analysis in early diagnosis of stable angina pectoris. Methods: dobutamine stress test was performed in 30 patients with chest pain, chest tightness and suspected stable angina pectoris. Coronary artery disease was confirmed by coronary CTA or coronary angiography. According to the results of coronary CTA or coronary angiography, all the patients were divided into coronary heart disease group (n = 20) and no coronary heart disease group (n = 10). Echocardiography was performed at rest, maximum load and reload at 30 min or 60 min to 120 min or 240 min after reload, respectively. The dynamic images of the left ventricular short axis section, apical four chamber, two chamber and three lumen section of 5 cardiac cycles were collected and stored. The results were further analyzed by QLab software. The longitudinal peak systolic strain and strain rate, the circumferential systolic peak strain and strain rate, the longitudinal and circumferential diastolic early and late strain rates were measured. The changes of regional myocardial systolic and diastolic function before and after load and over time were compared. Results: no segmental wall motion abnormalities were found in all subjects at rest and maximum load. At rest, in the control group and coronary heart disease group, the longitudinal peak systolic strain (LSs) and the strain rate (LSR) and the strain rate (CSS) and the strain rate (CSR), the early longitudinal relaxation, the late strain rate (LSReLSRa) and the early circumferential relaxation were observed in the control group and the coronary heart disease group. There was no significant difference in late strain rate (CSReN CSRaA). Under the maximum load, the LSN CS of ischemic myocardium in coronary heart disease group was significantly lower than that in control group and coronary heart disease group. At the maximum load, the control group, coronary heart disease (CHD) non-ischemic segment and ischemic segment (LSR-CSR) decreased compared with the rest state of the same group, and recovered to baseline level immediately after withdrawal of the drug. In the control group, the LSReg LSRaI CSRe and CSRa increased significantly in the control group, non-ischemic segment and ischemic segment of coronary heart disease at the maximum load. LSRe decreased immediately after dobutamine was stopped and was lower than baseline level. After 30min recovery, CSRe decreased slowly below baseline, and 60min recovered LSRA CSRa slowly decreased 30min to baseline level. Conclusion: the results of this study showed that there was no abnormal systolic and diastolic function of segmental ventricular wall in patients with stable coronary heart disease by two dimensional ultrasound dobutamine stress test. Two-dimensional dobutamine stress test revealed segmental myocardial systolic and diastolic dysfunction in patients with stable coronary heart disease. The results indicate that the analysis of strain and strain rate by two dimensional ultrasonic speckle tracing is of clinical significance for the early diagnosis of stable coronary heart disease.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.4

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相關(guān)博士學(xué)位論文 前1條

1 姚靜;多巴酚丁胺—美托洛爾負(fù)荷超聲心動(dòng)圖結(jié)合多普勒組織成像診斷冠心病的基礎(chǔ)與臨床研究[D];南京醫(yī)科大學(xué);2006年

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本文編號(hào)：1854620